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  5. Peter J. Bellafiore, MD, Inc.

Peter J. Bellafiore, MD, Inc.

Company Details

Name: Peter J. Bellafiore, MD, Inc.
Jurisdiction: Rhode Island
Entity type: Domestic Profit Corporation
Status: Activ
Date of Organization in Rhode Island: 19 Dec 1999 (25 years ago)
Identification Number: 000110031
ZIP code: 02882
County: Washington County
Principal Address: 360 KINGSTOWN RD UNIT 102, NARRAGANSETT, RI, 02882, USA
Purpose: TO PROVIDE NEUROLOGICAL HEALTH CARE TO PATIENTS.

Industry & Business Activity

NAICS

621111 Offices of Physicians (except Mental Health Specialists)

This U.S. industry comprises establishments of health practitioners having the degree of M.D. (Doctor of Medicine) or D.O. (Doctor of Osteopathy) primarily engaged in the independent practice of general or specialized medicine (except psychiatry or psychoanalysis) or surgery. These practitioners operate private or group practices in their own offices (e.g., centers, clinics) or in the facilities of others, such as hospitals or HMO medical centers. Learn more at the U.S. Census Bureau

Companies doing Offices of physicians (except mental health specialists)

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1982758207 2007-01-23 2020-08-22 70 KENYON AVE, SUITE 321, WAKEFIELD, RI, 028794239, US 70 KENYON AVE, SUITE 321, WAKEFIELD, RI, 028794239, US

Contacts
Phone +1 401-789-4885
Fax 4017920201

Authorized person
Name PETER J BELLAFIORE
Role OWNER
Phone 4017894885

Taxonomy
Taxonomy Code 2084N0400X - Neurology Physician
License Number MD8924
State RI
Is Primary Yes

Other Provider Identifiers
Issuer BCBS OF RI
Number 20877
State RI

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PETER J. BELLAFIORE, M.D., INC. 401(K) SAFE HARBOR RETIREMENT PLAN 2015 050507754 2016-04-20 PETER J. BELLAFIORE, MD, INC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 4017894885
Plan sponsor’s address 360 KINGSTOWN ROAD, SUITE 102, NARRAGANSETT, RI, 02882

Signature of
Role Plan administrator
Date 2016-04-20
Name of individual signing PETER J. BELLAFIORE, MD
Valid signature Filed with authorized/valid electronic signature
PETER J. BELLAFIORE, M.D., INC. 401(K) SAFE HARBOR RETIREMENT PLAN 2014 050507754 2015-04-24 PETER J. BELLAFIORE, MD, INC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 4017894885
Plan sponsor’s address 360 KINGSTOWN ROAD, SUITE 102, NARRAGANSETT, RI, 02882

Signature of
Role Plan administrator
Date 2015-04-24
Name of individual signing PETER J. BELLAFIORE, MD
Valid signature Filed with authorized/valid electronic signature
PETER J. BELLAFIORE, M.D., INC. 401(K) SAFE HARBOR RETIREMENT PLAN 2013 050507754 2014-09-15 PETER J. BELLAFIORE, MD, INC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 4017894885
Plan sponsor’s address 360 KINGSTOWN ROAD, SUITE 102, NARRAGANSETT, RI, 02882

Plan administrator’s name and address
Administrator’s EIN 050507754
Plan administrator’s name PETER J. BELLAFIORE, MD, INC
Plan administrator’s address 360 KINGSTOWN ROAD, SUITE 102, NARRAGANSETT, RI, 02882
Administrator’s telephone number 4017894885

Signature of
Role Plan administrator
Date 2014-09-15
Name of individual signing PETER J. BELLAFIORE, MD
Valid signature Filed with authorized/valid electronic signature
PETER J. BELLAFIORE, M.D., INC. 401(K) SAFE HARBOR RETIREMENT PLAN 2012 050507754 2013-08-23 PETER J. BELLAFIORE, MD, INC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 4017894885
Plan sponsor’s address 360 KINGSTOWN ROAD, SUITE 102, NARRAGANSETT, RI, 02882

Plan administrator’s name and address
Administrator’s EIN 050507754
Plan administrator’s name PETER J. BELLAFIORE, MD, INC
Plan administrator’s address 360 KINGSTOWN ROAD, SUITE 102, NARRAGANSETT, RI, 02882
Administrator’s telephone number 4017894885

Signature of
Role Plan administrator
Date 2013-08-23
Name of individual signing PETER J. BELLAFIORE, MD
Valid signature Filed with authorized/valid electronic signature
PETER J. BELLAFIORE, M.D., INC. 401(K) SAFE HARBOR RETIREMENT PLAN 2011 050507754 2012-09-11 PETER J. BELLAFIORE, MD, INC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 4017894885
Plan sponsor’s address 360 KINGSTOWN ROAD, SUITE 102, NARRAGANSETT, RI, 02882

Plan administrator’s name and address
Administrator’s EIN 050507754
Plan administrator’s name PETER J. BELLAFIORE, MD, INC
Plan administrator’s address 360 KINGSTOWN ROAD, SUITE 102, NARRAGANSETT, RI, 02882
Administrator’s telephone number 4017894885

Signature of
Role Plan administrator
Date 2012-09-11
Name of individual signing PETER J. BELLAFIORE, MD
Valid signature Filed with authorized/valid electronic signature
PETER J. BELLAFIORE, M.D., INC. 401(K) SAFE HARBOR RETIREMENT PLAN 2010 050507754 2011-10-12 PETER J. BELLAFIORE, MD, INC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 4017894885
Plan sponsor’s address 360 KINGSTOWN ROAD, SUITE 102, NARRAGANSETT, RI, 02882

Plan administrator’s name and address
Administrator’s EIN 050507754
Plan administrator’s name PETER J. BELLAFIORE, MD, INC
Plan administrator’s address 360 KINGSTOWN ROAD, SUITE 102, NARRAGANSETT, RI, 02882
Administrator’s telephone number 4017894885

Signature of
Role Plan administrator
Date 2011-10-12
Name of individual signing PETER J. BELLAFIORE, MD
Valid signature Filed with authorized/valid electronic signature
PETER J. BELLAFIORE, MD, INC 401(K) RETIREMENT PLAN 2009 050507754 2010-08-11 PETER J. BELLAFIORE, MD, INC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 4017894885
Plan sponsor’s address 360 KINGSTOWN ROAD, UNIT 102, NARRAGANSETT, RI, 02882

Plan administrator’s name and address
Administrator’s EIN 050507754
Plan administrator’s name PETER J. BELLAFIORE, MD, INC
Plan administrator’s address 360 KINGSTOWN ROAD, UNIT 102, NARRAGANSETT, RI, 02882
Administrator’s telephone number 4017894885

Signature of
Role Plan administrator
Date 2010-08-11
Name of individual signing CYNTHIA R. BELLAFIORE
Valid signature Filed with authorized/valid electronic signature
PETER J. BELLAFIORE, MD, INC 401(K) RETIREMENT PLAN 2009 050507754 2010-06-30 PETER J. BELLAFIORE, MD, INC 3
Three-digit plan number (PN) 001
Effective date of plan 2000-01-01
Business code 621111
Sponsor’s telephone number 4017894885
Plan sponsor’s address 360 KINGSTOWN ROAD, UNIT 102, NARRAGANSETT, RI, 02882

Plan administrator’s name and address
Administrator’s EIN 050507754
Plan administrator’s name PETER J. BELLAFIORE, MD, INC
Plan administrator’s address 360 KINGSTOWN ROAD, UNIT 102, NARRAGANSETT, RI, 02882
Administrator’s telephone number 4017894885

Signature of
Role Plan administrator
Date 2010-06-30
Name of individual signing CYNTHIA R. BELLAFIORE
Valid signature Filed with incorrect/unrecognized electronic signature
Role Employer/plan sponsor
Date 2010-06-30
Name of individual signing CYNTHIA R. BELLAFIORE
Valid signature Filed with incorrect/unrecognized electronic signature

Agent

Name Role Address
CYNTHIA R. BELLAFIORE Agent 360 KINGSTOWN ROAD UNIT 102, NARRAGANSETT, RI, 02882, USA

PRESIDENT

Name Role Address
PETER J. BELLAFIORE PRESIDENT 360 KINGSTOWN RD, UNIT 102 SAUNDERSTOWN, RI 02874 USA
PETER J BELLAFIORE MD PRESIDENT 71 PAMELA COURT SAUNDERSTOWN, RI 02874- USA

TREASURER

Name Role Address
CYNTHIA R BELLAFIORE TREASURER 71 PAMELA COURT SAUNDERSTOWN, RI 02874-1936 USA

SECRETARY

Name Role Address
CYNTHIA R BELLAFIORE SECRETARY 71 PAMELA COURT SAUNDERSTOWN, RI 02874-1936 USA

OTHER OFFICER

Name Role Address
PETER BELLAFIORE OTHER OFFICER 360 KINGSTOWN RD STE 102, 6 NARRAGANSETT, RI 02882 UNI

Filings

Number Name File Date
202446195720 Annual Report 2024-02-12
202328314450 Annual Report 2023-02-14
202209886250 Annual Report 2022-02-09
202192927260 Annual Report 2021-02-25
202034058970 Annual Report 2020-02-10
201984135300 Annual Report 2019-01-10
201856619150 Annual Report 2018-01-23
201731229900 Annual Report 2017-02-01
201691254130 Annual Report 2016-01-26
201554683110 Annual Report 2015-02-06

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
8323257305 2020-05-01 0165 PPP 360 KINGSTOWN RD, Unit 102, NARRAGANSETT, RI, 02882-3239
Loan Status Date 2021-06-22
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 51600
Loan Approval Amount (current) 51600
Undisbursed Amount 0
Franchise Name -
Lender Location ID 33209
Servicing Lender Name Berkshire Bank
Servicing Lender Address 99 North St, PITTSFIELD, MA, 01201-5114
Rural or Urban Indicator R
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address NARRAGANSETT, WASHINGTON, RI, 02882-3239
Project Congressional District RI-02
Number of Employees 5
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Corporation
Originating Lender ID 33209
Originating Lender Name Berkshire Bank
Originating Lender Address PITTSFIELD, MA
Gender Male Owned
Veteran Unanswered
Forgiveness Amount 52055.21
Forgiveness Paid Date 2021-04-01

Related by officers

No related officers

Related by address

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Date of last update: 10 Apr 2025

Sources: Rhode Island Department of State

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